2/28/2014

Islamic scholars draw out plan to combat polio


Leading Islamic scholars from all over the world led by the imam of the Grand Mosque on Thursday adopted a "Jeddah Declaration" and a focused six-month plan of action to address challenges facing polio eradication efforts in the few remaining polio-endemic parts of the Islamic world.
The declaration came at the end of the two-day meeting of the Islamic Advisory Group (IAG) for polio eradication at the headquarters of the Organization of the Islamic Cooperation (OIC) in Jeddah.
Representing various schools of Islamic scholarship and thought, the IAG was convened following a consultation of leading scholars in March 2013. The group is intended to bolster the support of the Islamic community and leadership for polio eradication and to communicate trust in the safety and effectiveness of vaccination.
The declaration seeks to address issues such as ban on vaccinations, lack of access to children in some areas, deadly attacks on health workers and misconceptions among the community about mass vaccination campaigns.
Addressing the media, IAG Chairman Saleh bin Humaid said the scholars at the meeting asserted that protection against diseases was obligatory and admissible under Islamic Shariah, and declared that any action which does not support these preventive measures and causes harm to humanity are un-Islamic.
Bin Humaid said that one of the important issues that came up during the meeting was security for polio vaccination workers following obstacles in the form of some extraordinary fatwas. The religious leaders denounced violence against health workers involved in polio vaccination campaigns, noting that such violence caused lasting harm to children and communities.
The remarks were made in the context of a growing climate of violence against health workers and facilities in situations of conflict and instability.
The scholars reiterated the safety and acceptability in Islam of vaccination against polio, saying it was a sin to claim the contrary and expose children to unnecessary risk. While most of the world, including the Muslim community of nations, is polio-free, the three countries which remain endemic for polio are largely Muslim — Pakistan, Nigeria and Afghanistan.
The group adopted a six-month action plan with focus on support to Pakistan and Somalia, which have the highest number of children paralyzed by polio. The IAG members will speak to national and local religious leaders on the religious duty of parents and communities to protect children and to allow health workers to carry out their duties for safety.
OIC Ambassador from Pakistan Abdelmoiz Bukhari, pointing out that the meeting also recommended involvement of university students in spreading awareness, said: “We in the general secretariat are very happy today to welcome such eminent partners with us in our fight against polio, which is a deadly disease.”
“There was agreement on the need to enhance efforts in this regard and to take all the necessary measures. I hope the action plan works in all the countries including Pakistan,” he added.
The group also resolved to ensure that information on the safety of vaccination is easily available to relevant religious and community leaders and to advocate for financial and technical support for polio eradication with the Islamic donor community.
The IAG is co-chaired by the International Islamic Fiqh Academy and Al-Azhar. The Jeddah-based Fiqh Academy and the Cairo-based Al-Azhar together with the Islamic Development Bank and OIC are the major founding members of the IAG. The group meets at the headquarters of the 57-member OIC in Jeddah.

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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here